Dormy House

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified 2 breaches of the regulations. The provider needed to improve recruitment processes to ensure staff employed in the service were suitable and people were not at risk of harm. The manager and provider did not always ensure safe and proper management of medicine. The completion of some of the medicine management records and checks needed reviewing and improving according to provider’s policy and current best practice guidance. However, people were safe living at the service and relatives felt their family members were kept safe. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse and felt confident issues would be addressed appropriately. The manager and the staff team were working with the local authority to investigate safeguarding cases and provided support to address any issues. The manager and staff had guidance to support people in the right way and oversee the risks. The manager reviewed and improved staff deployment to ensure people received timely or effective support. We observed kind and friendly interactions between staff and people. Relatives made positive comments about the staff and the care they provided. We observed the staff were organised better to ensure people were not at risk of social isolation and provided gentle stimulation to people. The manager ensured incidents and accidents were reviewed, the actions taken, and any lessons learned noted with themes or trends identified. The dedicated staff team followed procedures and practices to control the spread of infection and keep the service clean.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives were encouraged and supported to raise concerns. Relatives agreed they were kept informed if any incidents or accidents happened to their family member in the service. The manager ensured there was a culture of safety, openness and learning from events that could put people and staff at risk of harm.

The manager told us how they oversaw and monitored the service and any events at the service to ensure safety was a top priority that involved everyone, including the whole staff team, as well as, people and relatives. The manager said, “As a home manager, the care and safety are the ultimate priority for me. As a manager, when I come to work…I go around to see everyone as much as possible; speak to staff, to nurses, what happened last night or previously, anything I need to know, any support they need from me”. The manager told us they regularly communicated with the staff team using daily, weekly and monthly meetings, observing practice and keeping records regarding incidents, accidents, risks and any changes. The manager told us they had an open-door policy and encouraged staff to bring any issues or concerns to them. They said when they started at the service, there was a culture they had to change amongst the staff to ensure the staff team felt their views and feedback mattered and they were able to share their ideas to support people, discuss and act on any issues together. Any incidents, accidents, issues were discussed regularly to identify any lessons learned, as well as, themes and trends to support risk management. Staff supported people to raise any concerns and remain as safe as possible. Staff were aware how to report incidents and accidents and took action proactively to ensure people’s safety. Staff also discussed these events and any action plans required regularly with the managers.

There were incidents where the duty of candour applied. The provider had a policy that set out the actions staff should take in situations where the duty of candour would apply. People were supported to receive the required treatment and appropriate care and support was provided. Whilst the provider ensured people and families were kept informed and updated, the specific steps taken to meet the duty of candour requirements were not always recorded. We discussed this and requirements of the regulation with the manager to ensure clear record keeping. This would also ensure the provider acted in an open and transparent way with relevant persons in relation to the incidents. There was no negative impact to people. There was a system in place for recording accidents and incidents. The events would then be discussed within the team and ways to prevent it recurring would be identified and implemented. The manager completed a monthly review of all accidents and incidents, or as and when needed to ensure all relevant information was captured that supported effective risk management. The senior staff such as nurses would also review the information during clinical governance meetings to understand the events, action taken to improve practice and prevention. Information from these events would also be reviewed for any themes or trends analysis, communicated amongst the staff team, as well as, people, families, professionals as needed. The manager also provided information to all staff to be aware of all the incident and accident sent to CQC and local authority safeguarding team. By sharing such reports and discussing it, staff would understand the importance of keeping people safe as they care and support them, and take action to reduce the risk of incidents or accidents.

People and relatives were involved, informed and supported by the manager and the staff team who worked together with professionals to ensure continuity of care, including when people moved between different services or required temporary stays at the hospital. Relatives agreed they were involved and informed regarding their family members wellbeing as and when they required treatment from different services.

The registered manager explained how they worked together with professionals and others, through a collaborative, joined-up approach, to ensure safety and continuity of care was a priority throughout people’s care journey. For example, if the service was preparing for a potential admission, the manager worked together with people, their families, and professionals to gather and create plans of care so they could receive the care and support they needed. The manager and the staff team understood the risks to people across their care journeys and ensured information about people was available to help manage any risks in a proactive and effective way. The manager added that all the professionals involved were very supportive of the service and working proactively with them to look after people. Staff told us they ensured the care and support was planned and organised with people, including effective communication and liaising with professionals for different aspects of care and support that would ensure continuity.

Care and support were planned and organised with people, together with partners and communities in ways that would ensure continuity and positive outcomes for people. One professional said, “Yes, we work closely with management and nursing team and find them knowledgeable, honest and transparent. There has been a positive improvement with all processes and communication since [the manager] and [deputy manager] have been in post. The are using the [online] system effectively for raising alerts for deteriorating residents”. Another professional said, “The team at Dormy House is proactive in identifying and mitigating risks to residents. They conduct thorough assessments and share relevant information with us, allowing us to tailor our [services] accordingly. For instance, they have informed us about residents with specific health conditions that might impact [people’s] treatment, enabling us to adjust our approach to mitigate any risks”.

The manager worked in collaboration with staff, people and their relatives, and other partners to enable information sharing on risks and change. The manager established a more positive approach for staff to share feedback and gain learning that would help make improvements and bring about better outcomes for people. The manager and the staff team had variety of meetings happening regularly where different topics were discussed to ensure people were supported as needed, any issues were picked up in a timely manner and addressed and staff informed what should be done. This supported the manager to run the service smoothly. Where the manager picked up any gaps in practices, this was discussed with staff to come up with solutions and suggestions to ensure appropriate action was taken. A variety of topics had been discussed from people’s care, their daily life, activities their health and well-being as well as environment, premises, visitors, meals and any other business. The meeting minutes demonstrated the messages were shared to different teams to ensure staff provided support to people maximising the best outcomes for them.

People were protected from harm, neglect and discrimination. People felt safe and were able to seek support from staff if they had any issues or worries. One person added, “We are very safe here – [staff] really make sure that we are OK. Always looking out for us”. Relatives were able to contact or speak to staff or the manager if they needed to raise any queries or issues. One relative added, “It feels safer with the staff around who you know. I don’t have to worry about my relative – I know [person] is safe”.

The manager told us about their responsibilities regarding safeguarding people and reporting concerns to external professionals accordingly. They took timely actions to investigate to ensure concerns were addressed appropriately. The manager worked with staff to ensure people were supported to raise concerns when they did not feel safe and monitored for any changes in the safety of people. The manager and staff followed safeguarding systems, processes and practices to ensure there was learning and people’s human rights were upheld and they were protected from discrimination. The manager added, “As part of my framework, I always discuss safeguarding issues during the staff meetings, so they understand the process. Most of the time the staff will tell you the solution [to those issues]”. The manager shared information with the local authority and families, as well, in order to ensure transparency of the events and actions taken. The staff were encouraged to share any concerns with the manager or any other senior staff they felt comfortable with. Staff explained how to recognise abuse and protect people from the risk of abuse. Staff told us how to report concerns both at the service and to external authorities such as the local authority safeguarding team and were confident the manager would act on any concerns reported to ensure people's safety. People were supported to understand their rights, to feel safe and to receive care they needed.

During the visit to the service, we observed interactions between people and staff. People could seek support from staff and the managers at any time. Staff responded to people in a gentle, caring and kind manner, including when people became upset, distressed or anxious. Staff provided reassurance to people and helped them get back to their activities. Staff had an understanding of safeguarding and how to take appropriate action to ensure people were protected from abuse or harm. Professionals agreed the provider had appropriate systems, processes and practices to safeguard people from abuse. One professional added, “If any concerns or noted risks come up in the home we do feel that [the manager] and the teams would be transparent and continue to work with us on any new improvements”.

The provider had a safeguarding policy to support their systems, processes and practices to make sure people were protected from abuse and neglect. The manager and staff demonstrated there was a commitment to taking immediate action to keep people safe from abuse and neglect. The manager ensured any concerns related to people or the service were shared openly, quickly, and appropriately. The manager also encouraged a positive approach to reviewing such events to ensure staff were able to understand the risks and learn from them. Staff received training in safeguarding and had a good understanding about how to protect people from different forms of abuse. This supported people being safeguarded from the risk of abuse and having their rights upheld. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The manager had made DoLS referrals, where appropriate for people living in the service to ensure appropriate legal authorisations were in place when needed to deprive a person of their liberty.

People were protected from risks associated with their health, wellbeing and care. People told us staff supported and looked after them in a positive way. People said, “I do feel safe – because we are well looked after, and we have good food. If you want somebody to help you there is always someone around” and “Oh yes, it is safe. That is why I’m here. I wear an alarm all of the time…[Staff] told me that I had to wear it and that it was in case I fell or something. I am aware of them checking up on me at night”. Relatives were positive about the support and care people received. Relatives added, “Since January of this year things seemed to change – for the better. [Person] is now more relaxed and seems very content. The staff seem a lot happier and there is more engagement. I feel that [person] is safe as there is always a staff member around and they are so friendly. They really go out of their way to help” and “[The staff] are very aware of [the person] and we get a lot of updates. I talk to staff who know [the person] well. I feel they are doing the best they can. [Staff] know [the person] well enough to minimise incidents”.

The manager told us how they worked with people, their relatives and staff to understand and manage risks. This helped ensure the care met people’s needs in a way that was safe and supportive and enabled them to do the things that matter to them as much as possible. The manager continuously communicated with staff about people, their care, any changes and what action to take to address it. The manager said, “I always advocate to give people choices. We do risk assessments first, and possible things to happen and what worst things could happen. Then we put things in place in the least restrictive manner and put safety measures in place, and actions to minimise the risks. This is what we need to know - people’s life stories to support them better”. This supported a balanced and proportionate approach to risk that supported people and respected the choices they made about their care. The manager told us they reviewed people’s records every month or when changes happened. The manager added, “If there is an incident, then we review risk assessment for it, we don’t wait for the month to review it”. Staff used risk assessments and care plans contained up to date information to support people safely and effectively. Staff had a good level of understanding when identifying potential risks, managing actual risks, and keeping these under review. Staff shared information about people within the team on a regular basis, especially if there had been any changes to risks and related assessments. Staff told us how they supported people when they were upset, distressed or anxious. Any triggers would be considered to support review of people’s care. Both staff and the registered manager supported and protected people safely without any restrictions or use of restraint.

We observed when people communicated their needs, emotions or distress, staff were able to manage this in a positive way that protected their rights and dignity. Changes in people’s health or wellbeing were noted and reviewed so it would support the learning for the future about the causes of their distress. This helped adjust the plan of care to ensure people received the care and support they needed. We observed people were able to move freely around the service and staff did not place any restrictions on people. People had equipment in place such as sensor matts to alert staff of their movements and ensure the provision of timely and safe care as the least restrictive option.

People had care plans and risk assessments in place to minimise and mitigate the risks and promote choices. These risks included areas such as supporting people with mobility, equipment, nutrition, emotional wellbeing or with personal care. Risk assessments were clear including accurate guidance to help staff mitigate any risks. Information about risks and needs were kept under review and staff reported any changes promptly during regular meetings. Staff had training to support people with their emotional wellbeing and risk management. Staff monitored people for any changes which was also reviewed and discussed in handover and other regular meetings to share any information. If people’s needs and risks changed, the manager and the staff team worked with different health and/or social care professionals to ensure good and proportionate risk taking.

People were cared for in safe environments that helped meet their needs. The facilities, equipment and technology were well-maintained and consistently supported staff to deliver safe and effective care.

The manager and staff worked together to detect and control potential risks in the care environment. The manager told us how they ensured the equipment, facilities and technology supported the delivery of safe care which included completing regular checks for any issues in the service. The manager communicated with the maintenance team to report and request support to address the issues. The staff also monitored and recorded other general environmental risks, such as equipment checks, water temperatures, fire alarms and the kitchen area. Staff were aware and took actions where needed to ensure premises and environments kept people safe from harm or risk of harm. Staff agreed the provider ensured they had the right equipment to support people safely.

The premises were clean and well-maintained with fixtures, furnishings and furniture of appropriate quality. Communal areas presented a light, bright environment where people could move around freely. There were areas available for people to enjoy activities and spend time following personal interests or have visitors. We noted there was calm atmosphere and people were not rushed to do things. Many people had memory boxes with items of significance to them by their bedroom doors to help them identify which room was theirs.

There were some work and improvements ongoing to parts of premises safety such as fire safety, water safety management, electrical installation and to ensure the service had dementia friendly environment. There were entries missing on some of the maintenance checks records. More fire evacuation at night were needed to practice the process with night staffing numbers. We identified 2 doors that had quite wide gaps at the bottom when closed and this was rectified during our visit. There was some signage useful to people living with dementia indicating the doors for the toilet or other areas of the home. People had an option to hold on to a grab rail which was of a different colour so people could easily identify it. We found that more could be done for example, communal toilets and bathrooms had signs on the doors but there were no signs to lead people to the toilet or to other areas of the premises. During mealtimes, aids which could help with people's wellbeing could be used such as coloured crockery to support some individuals when eating. The menus displayed were not accessible to all the people due to the print size. However, people were supported to make choices in different ways such as staff communicating to them in preferred methods and displaying food options to make those choices. The manager provided us with dementia strategy action plan to note the work that has been ongoing to make improvements and changes that would have positive effect on managing a better experience for people living with dementia. Otherwise, there were arrangements to monitor and regularly check the safety and upkeep of the premises. Equipment used to deliver care and treatment was suitable for the intended purpose, stored securely and used properly.

Staff were available when people needed help or support and responded to people’s requests including when they used call bells. Relatives agreed staffing improved and they were happy with the care and support people received. People said, “[Staff] turn up quick enough when I call them – I use the call-bell. I’m patient enough to wait if they are busy elsewhere” and “If you need someone you can always find someone. I sleep well at night”.

The manager explained about the tools they used to ensure good numbers and mixture of staff and be able to meet people’s diverse needs effectively. This was reviewed monthly or as and when needed. The manager told us they worked with the staff team to help them and also they observed staff’s practice at the same time to pick up on any improvements but also to acknowledge good care. We spoke with the manager about recruitment and selection process that was completed by a dedicated team. Once the checks were completed, staff induction and training would start including having a buddy to work together for a few days as supernumerary. The manager told us about staff training to ensure there were enough qualified, skilled and experienced staff, who received support, supervision and development. The training also included completion of the care certificate which is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors. Staff told us they had enough staffing numbers and were able to do their job effectively and safely. Staff felt supported by the manager, senior staff and each other. Staff told us they had the training they needed to be able to support people well. Staff had support and supervision meetings to discuss their professional development needs and any other matters. Staff felt they could approach the manager and/or other senior staff for help and advice. However, further evidence reviewed for recruitment demonstrate the regulation and its requirements were not always followed.

Staff deployment had improved to ensure people received timely support. We observed staff were patient with people and were able to support people with their requests. During our visit, we observed people were involved in different activities and staff engaged well with people to ensure a level of stimulation.

The provider did not ensure the required information according to the regulation was gathered before staff started working at the service which put people at risk of being supported by unsuitable staff. In 7 staff files we found discrepancies with gathering full employment history and unexplained gaps in employment and evidence from previous employments related to health and social care regarding staff's conduct and verifying the reasons for leaving. The provider did not ensure required checks were consistently completed at the time of recruitment and the oversight of recruitment process had to be improved. Not having all required recruitment information before staff started work, could put people at risk of being supported by unsuitable staff. Staff completed variety of training topics the provider had determined was mandatory and role dependant training to meet people's needs and ensure their safety. When new staff started at the service, they had an induction, training completion and a period of shadowing experienced staff. The manager used different tools to review staffing numbers and deployment each month to make any adjustments needed. They used information of people’s needs, incidents or accidents, and any other contributing factors to review the staffing and make necessary adjustments. For example, the manager identified in certain part of the service, having a specific shift could benefit staff while supporting people with complex needs, being supper time and people getting ready for bed. This had a positive effect on the people’s care and reduced number of falls.

People were protected as much as possible from the risk of infection because premises and equipment were kept clean and hygienic. The service had dedicated staff to ensure they maintained their roles and responsibilities around infection prevention and control. People and relatives confirmed they did not have any issues with cleanliness of the service. People said, “[Staff] wash their hands and wear gloves and aprons when they do my personal care”, “There’s always someone cleaning” and “My room is kept clean. I do my own personal care”. One relative added, “It is very clean and I know when it wasn’t clean. The room would smell, and now I can compare it. [The person] is immaculate, never smells, and the room and unit never smell. There is a lot of cleaning going on”.

The manager and the staff team monitored and managed the risk of infection regularly. The manager told us any issues or risks detected were dealt with promptly with housekeeping staff. The manager worked together with the staff team and other professionals to support people to manage and get better when they had any infections. The manager noted the housekeeping team was very good at keeping the home clean. Staff told us the service was always clean kept clean on a daily basis. We noted to the manager there was some odour in one of the bedrooms. This was dealt with promptly with the person and their family involved to ensure they could change to another room so the odour could be eliminated.

We observed dedicated staff team ensured the service was kept clean, tidy and malodour free. Staff followed a cleaning schedule and used appropriate personal protective equipment to help protect people from the risks relating to cross infection. This way the provider was preventing people, staff and visitors from catching and spreading infections.

Appropriate measures were in place regarding infection control. The provider ensured staff had access and using protective personal equipment effectively and safely. The manager and senior staff were regularly reviewing and responding effectively to risks and signs of infection. The manager ensured infection outbreaks were effectively prevented or managed. Information about the risk of infection would be shared appropriately with relevant partners, including agencies, people using the service and visitors. The manager and the senior staff carried out audits to ensure standards of cleanliness were good.

People received their medicine safely. People said, “There is no problem with the medication – it is all done on time” and “The nurse comes round to make sure that I take my tablets. I would tell a nurse if I wasn’t feeling well”. Relatives told us they were happy with the way people’s medicine and health were managed. One relative added, “We discuss [medication support] openly and [staff] do not overmedicate [the person]. All is done with GP consent and we are always involved and kept up to date”. Staff supported people with taking their medicines in a calm and patient manner, ensuring they had their medicines at the right times.

The manager told us people’s medications had been assessed and reviewed regularly including when changes happened. People’s behaviour was not controlled by using medicines. The manager told us they worked with families, professionals to ensure medication management was correct and appropriate to the people. Only the registered nurses were supporting people with medication administration. The manager told us about the training they received and how they supported people to take medication. The manager also told us they regularly shared any updates with staff team to ensure they were following current guidance. Any medicine errors were discussed with staff as prat of lessons learned. The staff understood how to support people when they were upset or in pain, and to establish if they needed ‘as required’ medication, including understanding any non-verbal cues indicating pain or discomfort. One staff added, “You cannot rush. The trigger is going to be there if you rush. [Other techniques to calm down] is a walk in the garden with a staff member. However, we found some issues relating to management of medicine that did not reflect the feedback we gathered from leaders and staff.

Management of medicine needed further improvements. For example, people’s creams and ointments administration records were not managed consistently and not according to the policy. The medication administration record (MAR) sheets noted this information would be noted on provider’s electronic system when staff and nurses applied creams or ointments. However, the daily notes did not demonstrate this part of support was completed consistently. People did not always have topical MAR sheets in place to indicate how these topical medications should be managed to ensure desired effect. The provider’s policy noted staff supporting people with creams had to be appropriately trained to complete this task. However, this was not done and the manager acknowledged this. One person had sedative on a number of occasions and the outcome was noted as ‘ineffective’. We raised this with the managers regarding the reason it was continued to be given when it had no effect. Afterwards they raised this with GP to review and identify another medication to help with emotional wellbeing. However, this was not identified as part of the daily review of medicine. Protocols for ‘when required’ (PRN) medication needed more detailed information about people to describe any specific non-verbal cues they would express so that staff were able to identify their ailments to provide effective and timely treatment. PRN protocols needed more detail when supporting people to manage their emotions, moods and distress effectively, to ensure medication was used as the last resort. We raised this with the manager and they informed us during the visit the protocols were reviewed however this was not identified as part of management of medicine. The medication was stored securely in lockable rooms. The rooms were clean, tidy and cool.